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Home My WebLink About0480 OLD CRAIGVILLE ROAD - Health 480 OLD CRAIGVILLE RD. , CENTERVILLE - l_ A=247-034 No. 42101/3 ORA ESSE rE 10% 0 0 0 0 i f L1 No. / e Fee , O THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: F. Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0[ppYication for Migpomt *p!tem Construction i3ermit Application for a Permit to Construct( )Repair(Xpgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. "1 10 O 0`p GY kcjcJs�Le Owner's Name,Address and Tel.No. Gin�%Tt Assessor's Map/Parcel4—cel G[O Installer'ss Name,Address,and Tel.No. n/1 Designer's Name,Address and Tel.No. � A' o a -TnY w— t4y Type of Building: Dwelling No.of Bedrooms_ P Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow (�}c�-t7 gallons per day. Calculated daily flow -330 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank I S 6!9 Srl c_ Type of S.A.S. ,Z&tK:I.A-i,rcgrr/25' Description of Soil Nature of Repairs or Alterations(Answer when applicable) ��ST \� i�00 �t�c—Twrr�1L Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss Signed Date `j 1-gR:97— Application Approved by Date , C?'� Application Disapproved for the o lowing reasons Permit No. ,—=— f Vr Date Issued �-- 4A0 TOWN OF BARNSTABLE LOCATION 61 A- SEWAGE # 2 y j VILLAGE ASSESSOR'S MAP& LOT a Y�- 0_3� INSTALLER'S NAME&PHONE NO. i SEPTIC TANK CAPACITY I 0-C-5 LEACHING FACILrrY: (type) fdrr (size) NO.OF BEDROOMS �- BUMDER OR OWNER q �' PERMIT DATE: - ®O " F- 7 COMPLIANCE DATE: _3—l 7— �I Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 39 q ! a TOWN O��FBARNSTABLE LOCATION ��a 6A Z g, .-A..,�XVa 1 SEWAGE # 2 ZI VILLAGE ASSESSOR'S MAP & LOT 2 'f-• D-3 Y INSTALLER'S NAME&PHONE NO. �- - SEPTIC TANK CAPACITY I O� LEACHING FACILr Y: (type) (size) NO.OF BEDROOMS "Z BUILDER OR OWNER q� PERMTTDATE: 3 '1 z " F 7 COMPLIANCE DATE: 3 17 9 7 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Ll No. — � Fee _ THE COMMONWEALTH.OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for 0iootar *patent Construction permit Application for a Permit to Construct( )Repair(,. pgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Lj e O O Q GV s Owner's Name,Address and Tel.No. Assessor's Map/Parcel �'�wT� ( co ID Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms _ Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow E1-►-�� gallons per day. Calculated daily flow --A20 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank !S'60 !:- i Af -c-41. k Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b is Bo Hof ealth. Signed Date 9-Q-9 A lication Approved PP roved by Date Application Disapproved for the Rowipg reasons 1 Permit No. - 1' Date Issued THE COMMONWEALTH OF MASSACHUSETTS . BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ✓� Abandoned( )by�2pa . _r ►��a�." C at F v r ,n « &=!e PC A=n e.,er.N'C has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2!7_ // S dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date ' `i _ ET-7 _ Inspector ,--� '„> "N. No. - 4 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwigozal *pttent Congtruction Verntit Permission is hereby granted to Construct( )Repair( )'Upgrade( )Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: -1 - 9"7 Approved by r NOTICE: This Form is to be used for the Repair of Failed Septic Systems Unly CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT' (WrolOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated w— concerning the property located at L F0 04 e�� -��-�� Cam`"'` meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED : 1 / DATE: 3)D'f 7 _ LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. j:ccrt �, � �' � "� �ev� O 0 0